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General NPI Number Information
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NPI Number | 1780808675
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Entity Type | Organization
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Legal Business Name | LAURIE A BEACH
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Dates
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Enumeration Date | 04/12/2007
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Last Update Date | 02/12/2009
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Provider Practice Location Address
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Address Line | 212 COLLEGE ST
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City | PILOT GROVE
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State | MO
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Zip | 65276-1005
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Country | US
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Telephone | 660-834-5100
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Fax | 660-834-5101
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Provider Business Mailing Address
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Address Line | PO BOX 817
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City | CAPE GIRARDEAU
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State | MO
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Zip | 63702-0817
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Country | US
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Telephone | 573-335-4715
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Fax | 573-334-2303
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Authorized Official
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Title or Position | OWNER
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Name | MRS. LAURIE A BEACH
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Credential | FNP
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Telephone | 660-834-5100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR1300X
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Taxonomy Name | Rural Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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